Adult Old Exam 4 Practice Questions
Adam's bleeding is controlled with treatment. His lowest H&H, occurring 24 hours after admission, is 11.5 g/dl (115 g/L) and 32%. Two days after admission his NG tube is removed, and oral intake is started. In reviewing Adam's diet with him, you evaluate that he understands the dietary recommendations for PUD when he says: A."I can eat and drink most foods and fluids that don't cause me distress." B."I should substitute coffee and tea for alcohol at my social business functions." C."I must eat bland foods at least six times a day to promote healing of my ulcer." D."I should eliminate all milk and milk products because they stimulate gastric acid production."
A."I can eat and drink most foods and fluids that don't cause me distress."
Your client must undergo surgical intervention for IBD. Which comment indicates that additional instruction about the care of their new ileostomy is needed? A."I should change the appliance daily to prevent odors." B."When I change the appliance, I should check the skin for irritation." C."I should clean around the stoma with warm water and pat dry." D."I'll need to alter the appliance opening when the stoma becomes smaller as the area heals."
A."I should change the appliance daily to prevent odors."
A client is admitted with a diagnosis of hepatic encephalopathy. The nurse's assessment documentation would most likely include which of the following? A.Altered mental status B.Proficient concentration C.Increased energy D.Talkativeness
A.Altered mental status
Based on P.J.'s report of his drinking habits, you recognize the importance of monitoring the patient for withdrawal symptoms. Select the statements that accurately reflect alcohol withdrawal symptoms. There are four correct answers. A.Withdrawal should be anticipated if the patient reports consumption of over 10 drinks every day for a period of 2 weeks. B.Anxiety, agitation, weakness, nausea and/or vomiting are symptoms of alcohol withdrawal. C.Withdrawal symptoms will not begin until at least 12 hours after the last drink. D.Withdrawal symptoms usually peak at 24-48 hours after the last drink. E.Visual or auditory hallucinations may be present with alcohol withdrawal delirium.
A.Withdrawal should be anticipated if the patient reports consumption of over 10 drinks every day for a period of 2 weeks. B.Anxiety, agitation, weakness, nausea and/or vomiting are symptoms of alcohol withdrawal. D.Withdrawal symptoms usually peak at 24-48 hours after the last drink. E.Visual or auditory hallucinations may be present with alcohol withdrawal delirium.
Which type of precautions should the nurse implement to prevent hepatitis B exposure? A.Airborne B.Standard C.Droplet D.Exposure
B.Standard
The nurse is caring for a 42-year-old female whose stool is positive for blood per the hemoccult results from the lab. What assessment question is most important for the nurse to ask next? A.Have you recently noticed any changes in your bowel pattern? B.When was your last bowel movement? C.When was your last period? D.Have you been experiencing abdominal pain?
C.When was your last period?
The client has been experiencing difficulty and straining when expelling feces. Which intervention should the nurse discuss with the client? A.Explain some blood in the stool will be normal. B.Instruct the client in manual removal of feces. C.Encourage the client to use a cathartic laxative on a daily basis. D.Teach the client to eat a high-fiber diet.
D.Teach the client to eat a high-fiber diet.
The nurse is working with an admitted nursing student who completed the hepatitis B vaccination series 2 months ago. The student returns from the clinic with the following results: Hepatitis B Surface Antigen (HBsAg) = negative. How should the nurse interpret this result? A.The student is immune to hepatitis B B.The student is not immune to hepatis B C.The student is infected with hepatitis B D.The student needs to return to the clinic
D.The student needs to return to the clinic
Adam is very anxious about being in the hospital and keeps saying he can't afford to be away from work right now. When discussing the management of his illness after he is discharged, you recognize that at this time it is probably most important for him to A.stop smoking again. B.recognize symptoms of disease recurrence. C.avoid the use of over-the-counter medications for minor pains. D.use effective coping mechanisms to reduce business-related stress.
D.use effective coping mechanisms to reduce business-related stress.
Which of the following would be the priority focus of nursing care for a client with peritonitis? a.Fluid and electrolyte balance b.Gastric irrigation c.Pain management d.Psychosocial issues
a.Fluid and electrolyte balance
Postoperatively, a patient with an incisional cholecystectomy has a nursing diagnosis of ineffective breathing pattern related to shallow respirations secondary to a high abdominal incision. Which action should the nurse take first? a. Assess heart and lung sounds. b. Administer the prescribed analgesic. c. Position the patient on the operative side. d. Instruct the patient to cough and deep breathe.
b. Administer the prescribed analgesic.
The nurse explains to a patient with an episode of acute pancreatitis that the most effective means of relieving pain through suppression of pancreatic secretions is the use of a. antibiotics. b. NPO status. c. antispasmodics. d. proton pump inhibitors.
b. NPO status.
A patient diagnosed with nausea and vomiting from gastroenteritis is prescribed an intravenous (IV) fluid containing potassium chloride (KCl). Before administering the IV fluid, which of these assessments is the highest priority? a. Presence of tears b. Urine output c. Skin turgor d. Apical pulse
b. Urine output
Which assessment data best indicates the client recovering from an open cholecystectomy may require pain medication? a.Pulse is 65 beats per minute b.Shallow respirations c.Hypoactive bowel sounds d.Use of a pillow to splint when coughing
b.Shallow respirations
The clinic nurse is talking on the phone to a client who has diarrhea. Which intervention should the nurse discuss with the client? a.Tell the client to measure the amount of stool b.Recommend the client come to the clinic immediately c.Explain the client should follow the BRAT diet d.Discuss taking an over-the-counter histamine-2 blocker
c.Explain the client should follow the BRAT diet
When admitting a client to the hospital with suspected acute pancreatitis, which electrolyte disorder would be most expected? a.Hypoglycemia b.Hypernatremia c.Hypocalcemia d.hyperkalemia
c.Hypocalcemia
Which of the following assessment findings would be consistent with a client's diagnosis of cirrhosis? a.Increased amylase b.Increased pH level c.Increased prothrombin time d.Increased white blood cell count
c.Increased prothrombin time
For a definitive diagnosis of cirrhosis, the nurse will assist with which diagnostic test? a.Albumin level b.Colonoscopy c.Liver biopsy d.Liver enzyme levels
c.Liver biopsy
A patient with acute hepatitis B will be discharged tomorrow. The nurse should include which measures in the discharge teaching plan? a.Choose foods that are very hot or very cold. b.Participate in an exercise regimen to build stamina. c.Avoid alcohol for the first three weeks. d.Be sure to allow for periods of rest during the day.
d.Be sure to allow for periods of rest during the day.
Adam is discharge on quadruple therapy of a PPI, bismuth, metronidazole, and tetracycline. Ten days after his discharge from the hospital, Adam is readmitted with a suspected perforation of the ulcer. Select the assessment findings that indicate a perforation. Select all that apply. A.Decreased bowel sounds B.Grunting, shallow respiration C.Rigid, board-like abdomen D.Shoulder pain E.Sudden, severe upper abdominal pain
A.Decreased bowel sounds B.Grunting, shallow respiration C.Rigid, board-like abdomen D.Shoulder pain E.Sudden, severe upper abdominal pain
A colonoscopy reveals numerous diverticuli with the majority located in a section of the descending colon. What teaching should this patient receive? A.Increase fiber, fluids, and physical activity B.Avoid all foods with nuts and seeds C.Take acetaminophen for discomfort D.Take laxatives such as bisocodyl to prevent future episodes
A.Increase fiber, fluids, and physical activity
A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which of the following? A.Malaise B.Dark stools C.Weight gain D.Left upper quadrant discomfort
A.Malaise
P.J. has a nursing diagnosis of ineffective breathing pattern related to reduced lung volume. The most appropriate nursing intervention for him is to A.Place him in semi-Fowler's position. B.Promote deep breathing and coughing. C.Ensure that he is maintaining a low-protein diet. D.Perform oral and pharyngeal suctioning to reduce the risk of aspiration.
A.Place him in semi-Fowler's position.
The nurse is caring for a client diagnosed with GERD. Which intervention should be included for this problem? A.Teach the client to sleep with a foam wedge under the head. B.Encourage the client to decrease the amount of smoking. C.Instruct the client to take over the counter medications for pain relief. D.Discuss the need to attend Alcoholics Anonymous to quit drinking.
A.Teach the client to sleep with a foam wedge under the head.
The nurse is prioritizing care for a client 2 days after surgery for a stoma creation that resulted from ulcerative colitis. What is the most important issue for the nurse to address? A.Body image B. Ostomy care C.Sexual concerns D.Skin care
B. Ostomy care
The nurse is teaching a client recovering from a laparoscopic cholecystectomy. Which statement indicates the discharge teaching is effective ? A."I will take my lipid-lowering medication at the same time each night." B."I may experience some discomfort if I eat a high-fat meal in the next few weeks." C."I need someone to stay wit me for about a week after surgery." D."I should not splint my incision when I deep breathe and cough."
B."I may experience some discomfort if I eat a high-fat meal in the next few weeks."
The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What is the nurse's priority? A.Prevent all oral intake. B.Control abdominal pain. C.Provide enteral feedings. D.Avoid dietary cholesterol.
B.Control abdominal pain.
A patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. Which intervention should the nurse include in the patient's plan of care? A.Immediately start enteral feeding to prevent malnutrition. B.Insert an NG and maintain NPO status to allow pancreas to rest. C.Initiate early prophylactic antibiotic therapy to prevent infection. D.Administer acetaminophen (Tylenol) every 4 hours for pain relief.
B.Insert an NG and maintain NPO status to allow pancreas to rest.
A client is hospitalized with dehydration and dysphagia. Which task would not be appropriate to delegate to a licensed practical nurse? A.Administer a subcutaneous injection B.Perform initial swallow screen C.Assist the CNA with ambulating client D.Record vital signs on the electronic health record
B.Perform initial swallow screen
An important nursing intervention for the patient with a small intestinal obstruction who has an NG tube is to A.Offer clear liquids to sip PRN. B.Provide mouth care every 1 - 2 hours. C.Irrigate the tube with normal saline every 8 hours. D.Keep the patient supine.
B.Provide mouth care every 1 - 2 hours.
A STAT hemoglobin and hematocrit (H&H) is ordered for Adam, IV fluids are started at 125 mL/hr, and a nasogastric tube is inserted and connected to low continuous suction. Additional laboratory tests are also ordered. The results of Adam's initial H&H are 14.3 g/dL and 42%. You know that these results.... A.Should increase as fluid replacement is continued. B.Reflect an equal loss of plasma and red blood cells (RBCs). C.Indicate that A.D. has not lost a significant amount of blood. D.Are an indication for immediate transfusion with packed RBCs.
B.Reflect an equal loss of plasma and red blood cells (RBCs).
You are caring for the patient on post-op day 2. Bowel sound are hypoactive, abdomen is distended and tender to light palpation, patient denies passing flatus and reports spasms of abdominal pain. What intervention is most appropriate? A.Administer morphine sulfate IV per the prn order B.Report findings to the surgeon C.Assist the patient to ambulate in the hall D.Advise the patient this is expected due to NPO status.
C.Assist the patient to ambulate in the hall
You are caring for a patient post exploratory laparotomy who has refused pain medication since returning from post-anesthesia recovery (PAR) and now reports pain rated at 7/10. Blood pressure is 84/44; heart rate is 112. The patient demonstrates abdominal guarding and shallow respirations. What problem should be addressed first? A.Pain B.Breathing C.Circulation
C.Circulation
A client with irritable bowel syndrome has instructions to take psyllium 2 rounded teaspoons full twice a day for constipation. What is most important for the nurse to include in the teaching plan? A.Urine may be discolored. B.Stop taking the laxative once a bowel movement occurs. C.Each dose should be taken with a full glass of water or juice. D.Daily use may inhibit the absorption of some fat-soluble vitamins.
C.Each dose should be taken with a full glass of water or juice.
A 42-yr-old nurse has been diagnosed with PUD. The medication regimen includes misoprostol, a cytoprotective agent. The nurse understands that this medication exerts its therapeutic effect by: A.Neutralizing excess gastric acid B.Inhibiting HCl production C.Supporting mucous production D.Increasing gastric emptying time
C.Supporting mucous production
A 46-yr-old client has been experiencing frequent episodes of "heart burn" and regurgitation of sour-tasting fluid, especially after a large meal. The client is diagnosed with a hiatal hernia. The nurse knows that the client understands her treatment regimen when she states she will: A.Elevate her legs when she is sleeping. B.Increase her roughage in her diet C.Drink more fluids with her meals. D.Avoid caffeine, alcohol, and chocolate.
D.Avoid caffeine, alcohol, and chocolate.
A client is diagnosed with acute gastritis secondary to alcoholism and cirrhosis. The client reports frequent nausea, pain that increases after meals, and black, tarry stools. The client recently joined Alcoholics Anonymous. The nurse should give priority to which client history item? A.Black, tarry stools B.Frequent nausea C.Joining Alcoholics Anonymous D.Pain that increases after meals
A.Black, tarry stools
Which intervention is most important when preventing the transmission of hepatitis A? A.Careful hand washing B.Standard precautions C.Effective sewage disposal D.Good personal hygiene
A.Careful hand washing
A self-help group of clients with irritable bowel syndrome have invited a nurse to present a program on nutrition. Which substance should the nurse teach the clients to minimize in the diet to decrease gastrointestinal (GI) irritability? A.Cola drinks B.Gelatin C.Fiber D.Rice
A.Cola drinks
Adam has no postoperative complications and progresses well in his recovery. You plan teaching for Adam in preparation for his discharge. Select all that apply. A.Drink at least 8 oz of fluid with meals. B.Teaching about dumping syndrome management. C.Eat small, frequent meals with moderate amounts of protein and fat. D.Follow-up visits will be needed to evaluate the need for cobalamin injections. E.Maintain lifestyle changes previously used to prevent ulcer redevelopment.
B.Teaching about dumping syndrome management. C.Eat small, frequent meals with moderate amounts of protein and fat. D.Follow-up visits will be needed to evaluate the need for cobalamin injections. E.Maintain lifestyle changes previously used to prevent ulcer redevelopment.
A nurse is caring for a group of clients. On review of the clients' medical records, the nursing determines that which client is at risk for excess fluid volume? A.The client on diuretics B.The client with renal failure C.The client with an ileostomy D.The client on gastrointestinal suctioning
B.The client with renal failure
The client diagnosed with liver problems asks the nurse "Why are my stools clay-colored?" On which scientific rationale should the nurse base the response? A.There is an increase in serum ammonia levels. B.The liver is unable to excrete bilirubin. C.The liver is unable to metabolize fatty foods. D.A damaged liver cannot detoxify vitamins.
B.The liver is unable to excrete bilirubin.
The nurse has been assigned to care for a client diagnosed with peptic ulcer disease. Which assessment data requires further intervention? A.Bowel sounds auscultated 15 times in one minute B.Belching after eating a heavy and fatty meal late at night C.A decrease in systolic blood pressure of 22 mm Hg from lying to sitting D.A decreased frequency of distress located in the epigastric region
C.A decrease in systolic blood pressure of 22 mm Hg from lying to sitting
Which of the following orders would you question for this patient? A.Daily weights, abdominal girth measures, and I & O B.CIWA protocol to assess for ETOH withdrawal C.Acetaminophen prn for pain D.Nutritional support: multivitamins (po or IV), high carb/low fat diet (individualized orders for protein and fluids); oral care E.Prep for paracentesis
C.Acetaminophen prn for pain
A nurse is caring for a client who has developed dysphagia and is unable to swallow. The client is receiving around-the-clock opioid pain medications for cancer pain, and hospice has recently begun caring for the client. What is the best nursing intervention in preparing for the client's discharge? A.Contact the client's healthcare provider to ask to substitute a liquid form of medications for the pill form. B.Teach the client and family members to crush the pills and administer them with applesauce. C.Teach the client and family members about addiction that may occur as a result of regular opioid use. D.Contact the client's healthcare provider to discuss use of transdermal medications for pain control.
D.Contact the client's healthcare provider to discuss use of transdermal medications for pain control.
The health care provider orders lactulose for a patient with hepatic encephalopathy. Which finding indicates the medication has been effective? A.Relief of constipation B.Relief of abdominal pain C.Decreased liver enzymes D.Decreased ammonia levels
D.Decreased ammonia levels
The nurse is counseling a client on how to prevent cholecystitis. What is the most important guideline for the nurse to include? A.Eat a low protein diet B.Eat a low fat, low cholesterol diet C.Limit exercise to 10 minutes a day D.Keep weight proportional to height
D.Keep weight proportional to height
A patient with advanced cirrhosis who has ascites is short of breath and has an increased respiratory rate. What is the most appropriate action by the nurse? A.Initiate oxygen therapy at 2 L/min to increase gas exchange. B.Notify the health care provider so that a paracentesis can be performed. C.Ask the patient to cough and breathe deeply to clear respiratory secretions. D.Place the patient in semi-Fowler's position to relieve pressure on the diaphragm.
D.Place the patient in semi-Fowler's position to relieve pressure on the diaphragm.
A patient is admitted for appendicitis. What manifestations does the nurse expect? A.LUQ or epigastric pain, radiating to the back B.LLQ pain, fever, and constipation C.RUQ pain, fatigue, anorexia, and jaundice D.RLQ pain, guarding, rebound tenderness
D.RLQ pain, guarding, rebound tenderness
The home health nurse is caring for a client with viral hepatitis. Which intervention should the nurse discuss with the client? a.Limit water intake to 1000 mL per day. b.Eat a high fat diet. c.Take acetaminophen for fever. d.Eat small, frequent meals.
d.Eat small, frequent meals.
Upon reviewing the history of a client with chronic gastritis, which of the following may be a risk factor for the development of this condition? a.Adolescent client b.Antibiotic usage c.Gallbladder disease d.Helicobacter pylori infection
d.Helicobacter pylori infection
Which factor should be the initial focus of nursing management in a client with acute pancreatitis? a.Dietary management b.Prevention of skin breakdown c.Management of hypoglycemia d.Pain control
d.Pain control
